Provider Demographics
NPI:1053838961
Name:NEUROBEHAVIORAL HOSPITAL, LLC
Entity type:Organization
Organization Name:NEUROBEHAVIORAL HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP BOD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-319-6552
Mailing Address - Street 1:112 W JEFFERSON BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1921
Mailing Address - Country:US
Mailing Address - Phone:219-648-2400
Mailing Address - Fax:219-472-0369
Practice Address - Street 1:9330 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9830
Practice Address - Country:US
Practice Address - Phone:574-277-2630
Practice Address - Fax:574-485-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital